Pharmacy World and Science

, Volume 15, Issue 5, pp 225–229 | Cite as

Slow replenishment of carnitine deficiency after cessation of long-term treatment with pivaloyl-containing antibiotics

  • Quy N. Diep
  • Thomas Bøhmer
  • Jan I. Holme
  • Ansgar Torvik
  • Olav T. Storrøsten
  • Christian W. Loennecken
  • Per Monstad
  • Egil Jellum
Practice/Case Reports


Long-term treatment with pivampicillin and pivmecillinam for 6–24 months in five adults and one child reduced the total serum carnitine concentration to 3.7–14 μmol/l (reference value: 25–66 μmol/l). Muscle carnitine was reduced to 0.3–0.7μmol/g wet weight (reference value: 3–5μmol/g) in two cases. All patients had muscle symptoms with weakness, asthenia and pains. One showed signs of carnitine depletion in the liver with increased secretion of dicarboxylic acids (C6, C8, C10) in urine and limited ketone body formation during prolonged fasting. Serum carnitine increased slowly after cessation of therapy and reached normal concentrations after 6–12 months. All symptoms caused by carnitine depletion disappeared. This was achieved on a normal diet without carnitine supplementation.


Carnitine/deficiency Dicarboxylic acids Diet Pivampicillin Pivmecillinam 


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Copyright information

© Periodicals Service Company 1993

Authors and Affiliations

  • Quy N. Diep
    • 1
  • Thomas Bøhmer
    • 1
  • Jan I. Holme
    • 2
  • Ansgar Torvik
    • 3
  • Olav T. Storrøsten
    • 4
  • Christian W. Loennecken
    • 5
  • Per Monstad
    • 6
  • Egil Jellum
    • 7
  1. 1.Medical DepartmentAker University HospitalOsloNorway
  2. 2.OsloNorway
  3. 3.Department of PathologyUllevål University HospitalOsloNorway
  4. 4.Department of PediatricsAker University HospitalOsloNorway
  5. 5.Ring Medisinsk a.s.OsloNorway
  6. 6.Haugesund HospitalHaugesundNorway
  7. 7.Institute of Clinical BiochemistryOsloNorway

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